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Research activities in Orange Farm Bertran Auvert INSERM University of Versailles, France Country update meeting on scaling - up of male circumcision programmes.

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Presentation on theme: "Research activities in Orange Farm Bertran Auvert INSERM University of Versailles, France Country update meeting on scaling - up of male circumcision programmes."— Presentation transcript:

1 Research activities in Orange Farm Bertran Auvert INSERM University of Versailles, France Country update meeting on scaling - up of male circumcision programmes in the southern and eastern Africa Region Arusha, Tanzania, June 2010

2 Background Orange Farm About people Objective of the current project (Bophelo pele) To roll out MC To study the effect at community level (sexual behavior, HIV) Schedule 2007: S1: baseline cross sectional survey (men and women) 2008  Roll out of MC 2011: S2: Second cross sectional survey 2013: S3: Third cross sectional survey S1 (baseline) MC roll out S S3

3 1 Uptake of MC Objective: Proportion of uncircumcised men who will accept to become circumcised? Methods: Cross sectional survey S2 in 2011 (3 years after the beginning of the roll out) Questionnaire Genital examination Results: Before 2008: MC prevalence=15% After the roll out? In %? 60%? S1 (baseline) MC roll out S S3

4 2 Who is coming for MC? Objective: To compare those who are coming for MC with those who did not come. Comparison on HIV and sexual behavior Methods: Sample among those who are coming for MC (2010) Sample among uncircumcised (2011 survey) Questionnaire (sexual behavior, condom use) Blood sample (HIV prevalence and incidence) Other STIs (HSV-2, HPV, NG, CT) Results: More at risk? Less at risk? Difference in HIV prevalence, incidence? S2

5 3 Effect of MC on sexual behavior Objective: To compare those who are coming for MC with those who were recently circumcised. Comparison on sexual behavior Methods: Sample among those who are coming for MC (2010) Sample among recently circumcised (2011 survey) Questionnaire (sexual behavior, condom use) STIs as a proxy of sexual behavior (NG, CT) Results: Risk compensation? S2

6 4 Effect of MC on HIV among women Objective: To compare HIV among women having had a partner circumcised during the partnership not having had a partner circumcised during the partnership Methods: Sample among women (2011 survey) Questionnaire (MC status of partner, sexual behavior, condom use) Blood sample tested for HIV Results: Can we detect any difference in HIV incidence? S2

7 5 Effect of the roll out on HIV Objective: To compare HIV incidence between those who came for MC who didn’t come for MC Methods: Sample among men (2011 survey) Questionnaire (sexual behavior, condom use) Clinical examination Blood sample tested for HIV Repeat the study in 2013 (S3) Effect on other STIs (HSV-2, HPV) Results: Can we detect any difference in HIV incidence? Sample size of the 2013 survey? S S3

8 HIV incidence ? It is used for HIV incidence. Does it work for comparison of HIV incidence (HIV incidence ratios) ? Using the blood sample collected at the final follow up visit MC trial 2946 blood tube 194 HIV+ 121 Tested as “recently infected” (18 months)  RR of HIV infection (incidence rate ratio) 53% (30% to 70%) * Trial :60% (34% to 76%) “Recently” infected “Not recently” infected “Recently”: BED incidence assay  3 to 18 months (cut off) Careful: correction for false recently infected, those under ARVs * BMC Infect Dis May 27;10(1):137 HIV incidence assay

9 Acknowledgement Orange Farm population (South Africa) Bophelo Project team (South Africa) ANRS (France) University of Versailles (France INSERM (France) NICD – NHLS (South Africa)


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